Risk Factors Of In-stent Restenosis Of Vertebral Artery Origin:A Meta-analysis

Objective:Intravascular stent implantation is an important method for the treatment of severe atherosclerotic stenosis and reduction of posterior circulation ischemic events at the beginning of vertebral artery.The success rate of the operation is high,which can effectively reduce the degree of vascular stenosis.However,many studies have shown that the rate of restenosis in the stent is higher after operation.So,we apply the method of Meta analysis,to systematically review the risk factors of in-stent restenosis of vertebral artery origin to provide the theories foundation for the clinical prevention and treatment.Methods:Taking vertebral artery?vertebrobasilar insufficiency?stents?drug-eluting stents?self expandable metallic stents in English as the key words,retrospective clinical study about risk factors of in-stent restenosis of vertebral artery origin were searched by using PubMed,Embase,The Cochrane Library,CNKI,CBM,WanFang Data and VIP database from database construction to March 30,2017.Quality assessment and Meta analysis were made by using Newcastle-Ottawa Scale(NOS)and Stata 12.0software.When P>0.100 and I~2?50.000%,we think that there is no heterogeneity between data.We use a fixed effect model to analyze the merger effect.When P?0.100 and I~2>50.000%,we think there is a heterogeneity between the data.At this time,the random effect model is used to analyze the merger effect and analyze the source of its heterogeneity.The sensitivity of Meta analysis was analyzed,and the Egger method was used to detect publication bias.Results:The research enrolled 3468 articles,from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria.A total of 11studies with a total number of 1352 patients which divided into restenosis group(n=440)and non-restenosis group(n=912).The smokers stent restenosis incidence was higher than non-smokers(OR=2.179,95%CI:1.373~3.458,P=0.001),the utilization rate about bare metal stents(OR=2.072,95%CI:1.560~2.753,P=0.000),drug-eluting stents(OR=0.483,95%CI:0.363~0.641,P=0.000)between the restenosis group and non-restenosis group was statistically significant.(p<0.050).Conclusion:Smoking and using bare metal stents were risk factors of in-stent restenosis of vertebral artery origin,and using drug-eluting stents were protective factors.